Category: Covid-19

Anil Makam, MD, MAS, works with a patient in an ICU room at Zuckerberg San Francisco General Hospital in San Francisco. Makams research looks at the long-term effects of severe COVID-19 illness among the sickest of survivors early in the pandemic. Photo by Erin Lubin

UC San Francisco researchers examined COVID-19 patients across the United States who survived some of the longest and most harrowing battles with the virus and found that about two-thirds still had physical, psychiatric, and cognitive problems for up to a year later.

The study, which appears April 10, 2024, in the journal Critical Care Medicine, reveals the life-altering impact of SARS-CoV-2 on these individuals, the majority of whom had to be placed on mechanical ventilators for an average of one month.

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64% of study participants reported having a persistent impairment after one year, including:

Physical 57% Respiratory 49% Psychiatric 24% Cognitive 15% Continued use of supplemental oxygen 19%

Nearly half, or 47%, had more than one type of problem.

Too sick to be discharged to a skilled nursing home or rehabilitation facility, these patients were transferred instead to special hospitals known as long-term acute care hospitals (LTACHs). These hospitals specialize in weaning patients off ventilators and providing rehabilitation care, and they were a crucial part of the pandemic response.

Among the 156 study participants, 64% reported having a persistent impairment after one year, including physical (57%), respiratory (49%), psychiatric (24%), and cognitive (15%). Nearly half, or 47%, had more than one type of problem. And 19% continued to need supplemental oxygen.

The long-term follow up helps to outline the extent of the medical problems experienced by those who became seriously ill with COVID early in the pandemic.

We have millions of survivors of the most severe and prolonged COVID illness globally, said the studys first author, Anil N. Makam, MD, MAS, an associate professor of medicine at UCSF. Our study is important to understand their recovery and long-term impairments, and to provide a nuanced understanding of their life-changing experience.

Researchers recruited 156 people who had been transferred for COVID to one of nine LTACHs in Nebraska, Texas, Georgia, Kentucky, and Connecticut between March 2020 and February 2021. They questioned them by telephone or online a year after their hospitalization. The average total length of stay in the hospital and the LTACH for the group was about two months. Their average age was 65, and most said they had been healthy before getting COVID.

In addition to their lingering ailments from COVID, the participants also had persistent problems from their long hospital stays, including painful bedsores and nerve damage that limited the use of their arms or legs.

Many of the participants we interviewed were most bothered by these complications, so preventing these from happening in the first place is key to recovery, Makam said.

Although 79% said they had not returned to their usual health, 99% had returned home, and 60% of those who had previously been employed said they had gone back to work.

They were overwhelmingly grateful to have survived, often describing their survival as a miracle. But their recovery took longer than expected.

The results underscore that it is normal to for someone who has survived such severe illness to have persistent health problems.

The long-lasting impairments we observed are common to survivors of any prolonged critical illness, and not specific to COVID, and are best addressed through multidisciplinary rehabilitation, Makam said.

Authors: Additional UCSF co-authors include Oanh Kieu Nguyen, MD, MAS, Eddie Espejo, MA, Cinthia Blat, MPH, W. John Boscardin, PhD and Kenneth E. Covinsky, MD, MPH.

Funding: The work was supported by grants from the National Institutes of Health/National Institute on Aging (K23AG052603), the UCSF Research Evaluation and Allocation Committee (Carson and Hampton Research Funds) and the National Association of Long Term Hospitals. The authors had no conflicts of interest to disclose.

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Survivors of Severe COVID Face Persistent Health Problems - UC San Francisco

Theo Huot de Saint-Albin was a 9-year-old elementary school student when he first contracted COVID-19 in July 2020, near the start of the coronavirus pandemic.

Four years later, as much of the world has moved on from the pandemic and resumed normal life, Theo, now nearly a teenager, is still battling the effects of long COVID.

"What happened directly after COVID-19 was worse than my actual COVID-19," Theo, now in seventh grade, told "Good Morning America." For me, I have chronic migraines ... it doesn't mean the migraine is terrible every day. It's very unpredictable. It goes in waves. But it's always there. It never leaves."

Over the past four years, Theo has contracted COVID-19 a total of three times, and each case has been mild. It's what happens in the weeks and months after the COVID-19 diagnosis that he says has impacted his ability to learn, go to school and play with friends.

In addition to battling chronic migraines, Theo was also diagnosed with postural orthostatic tachycardia syndrome, or POTS, a blood circulation disorder that can cause dizziness, lightheadedness and a rapid heartbeat, according to the U.S. National Institute of Neurological Disorders and Stroke.

He said he also suffers from symptoms like muscle pain, extreme fatigue and brain fog, and takes around two dozen medications and supplements each day to help manage his symptoms.

"There's no real way to tell how I'm going to feel," Theo said, noting that some days he is able to go to school for only a half-day, while other days he feels closer to his pre-COVID-19 self, and still others he can't move beyond the couch all day.

"It's especially hard because it's 'invisible,'" Theo said of his long COVID diagnosis. "Sometimes it's hard to get people to believe you as well because they can empathize with something they know is there. 'Oh, you have a broken leg, I can see that. Wow, you can't walk. That must be tough.' But, your head hurts? 'I don't see a big bulge on your head. I don't see bandages wrapped around it.'"

While battling long COVID can seem lonely, Theo is far from alone, data shows.

An analysis published in February in the journal Pediatrics reported that as many as 5.8 million children in the United States have developed long COVID, or between 10% to 20% of children who have contracted COVID-19.

Figures from the Centers for Disease Control and Prevention show a smaller but still noteworthy estimate of 1.3% of children in the U.S. having had long COVID as of 2022.

Long COVID is diagnosed when patients still have symptoms at least four weeks after they have cleared the infection, according to the CDC. In some cases, like Theo's, symptoms can be present for months or years.

It's not clear if long COVID symptoms last a lifetime. Many people eventually recover, but scientists are still working to understand who is most affected, and why.

Symptoms vary and can include fatigue, difficulty breathing, headaches, dizziness brain fog, joint and muscle pain and continued loss of taste and smell, according to the CDC.

In kids, symptoms of long COVID can also include rashes, diarrhea, heart issues and diabetes, according to the research published in Pediatrics.

Part of the complication with long COVID is there is no single test or bloodwork to diagnose it. Instead, doctors have to rule out other conditions and rely on patients to describe and track their symptoms, which can be difficult with kids.

For Theo, it took nearly two years for him to be diagnosed with long COVID, according to his mom Meredith Eubanks.

Eubanks said she was told "no" by doctors when she would ask if her son might have long COVID, and faced misdiagnoses along the way, like Lyme disease. Both she and Theo struggled to answer when asked roughly how many doctors he had seen over the past four years.

In April 2022, Eubanks said Theo was diagnosed with long COVID by an infectious disease group at a local children's hospital in Atlanta, where the family lives. But the hospital, according to Eubanks, had no answer to her question of "Now what?" in terms of treatments and rehabilitation.

For that, the family traveled over 600 miles to Baltimore, where Dr. Laura Malone, a pediatric neurologist, had established the Pediatric Post-COVID-19 Rehabilitation Clinic at the Kennedy Krieger Institute, a pediatric-focused nonprofit health organization affiliated with Johns Hopkins Medicine.

"They were the first place we got to where they were like, 'Here's a list of symptoms, and did you have any pre-COVID, and what did you have post-COVID?'" Eubanks said, recalling how Theo checked nearly all of the symptoms on the list. "I just remember that was such relief. It was just like, 'Oh, you know, they're recognizing this and it's official, and Theo is not alone.'"

Malone said she and her team at the Kennedy Krieger Institute established the clinic in the summer of 2020 as they saw reports of adults developing long COVID. As the pandemic continued, demand began to grow.

"Everybody was, early in the pandemic, very focused on hospitalized cases, and the sequela after people get care in the ICU or are very critically ill with the acute infection, and that's not generally what we see in pediatrics," Malone said. "Most children can have a relatively mild infection and then go on to develop long-term sequela. So, that took a little bit of time to recognize and for patients to seek care, both from their primary care doctors and then also from clinics like us."

As long COVID became more recognized, Malone said the clinic has seen steady demand from pediatric patients across the country, while she said other patients may go undiagnosed.

"You have to look at a lot of behavioral changes, especially in younger children, to say, 'Something seems off'.' So I do think that [long COVID] is probably a little bit under-recognized still," Malone said. "We do see that there can be a lot of resiliency in children, and so despite them sometimes maybe having the symptoms, they may not always bring it up to family members or doctors but rather just try and manage the symptoms, and it's only when it gets to be intolerable that sometimes it will present to more medical care."

Along with there being no diagnostic test for long COVID, there is also no cure for the condition. Much of what can be done for patients is symptom management, according to Malone.

For kids, she said that means helping them manage their symptoms so they can, at least to some degree, return to school and social activities.

"Participation in life and all the activities, including education, that kids are designed to be participating in is really important," Malone said. "One of our big focuses is to try to provide accommodations to get kids back into school, but meet them where they are, because they may not be able to do a full course load, or they may not be able to make it through the full day of school, but there is still benefit if they can go for an hour, and gradually increase that over time to getting them back into that sort of routine, and getting them back into the social aspects of school and the educational aspects."

Patients at the clinic see not only medical doctors like Malone, but a team of experts including behavioral and neuropsychologists, social workers, pain specialists and physical therapists.

Ellen Henning, Ph.D., a pediatric psychologist at the Kennedy Krieger Institute, said patients often struggle with anxiety and depression due to long COVID. She said new research is also suggesting that long COVID itself could be influencing mental health symptoms due to factors like inflammation in the brain and lower levels of serotonin.

"We learn new things constantly and we adjust as we as we go," Henning said. "We try to provide the best supports that we can and then we all are always integrating new knowledge and adjusting things as we need to."

In October, the clinic received a $5 million grant from the Department of Health and Human Services that it is using to help train school nurses and other community health care providers to identify long COVID in students and provide accommodations for students already diagnosed with the condition.

"We have a lot of families and children that say that they have to educate, sometimes, their providers and tell their doctors at home about what's going on and about long COVID," Malone said. "That can just be really exhausting for kid, so that's a big thing that we've been working on, and we're really proud of that."

Theo said while his long COVID symptoms continue, he has felt more at ease since receiving his diagnosis and as the condition becomes more recognized.

With the help of Malone and the team at the Kennedy Krieger Institute, Theo is back in school for periods of time and working on catching up with his classmates.

"We have a lot of hope," he said. "I know I'm going to finish school at some point. Maybe a little later than most people, but who knows. And I think I'm going to get better. With all the research that's going to come out, hopefully, something will help me more than anything else."

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12-year-old describes 4-year battle with long COVID - ABC News

While most people recognized that the pandemic was a catalyst for buying groceries online, few could fully anticipate the implications of that surge, said David Bishop, partner at Brick Meets Click. Now, four years after COVID-19 first impacted our everyday lives, eGrocery in the U.S. looks very different from both a contribution and growth perspective, and this will impact how grocers and others expand and drive profitability in their respective businesses moving forward.

From a contribution perspective, Pickup and Delivery share has grown at the expense of Ship-to-Home. Pickup, which accounted for less than one-third of eGrocery sales in 2019, quickly moved to the top spot when the pandemic started and it has stayed there ever since. Delivery, which represented one-quarter of all online sales in 2019, experienced an even larger jump in market share, to 39.1 percent.

Online grocery sales for March peaked in 2021 and have declined or been flat on a year-over-year basis since then. The ongoing research shows that the size of the online grocery customer pool has become more well-defined and that future growth will likely happen more gradually. In March 2024, the total eGrocery customer pool (which consists of active and lapsed or infrequent users), expanded to include 78.6 percent of all U.S. households. At the end of the first month of the pandemic in 2020, online grocery household penetration finished at 70.8 percent.

The overall eGrocery Monthly Active User base as a share of total households more than doubled at the start of COVID-19, finishing March 2020 at 57.5 percent, the share of MAUs since then has generally remained in the 50 percent range.

"Helping customers build their basket of goods by using tactics like personalized offers or targeted deals is not just key to growing sales but also to improving the chances that theyll come back again, said Mark Fairhurst, global chief growth officer at Mercatus. For todays grocers, keeping your online customers engaged is more important than ever as growth is now more likely derived from increased order frequency and/or spend per order.

Another challenge for most brick-and-mortar grocers is building a mobile app that assists customers as they shop, whether thats online or in-store. Mass retailers, like Walmart and Target, have already invested heavily in enhancing the perceived value from using their mobile apps and it shows.

The latest research found that 76 percent of households that primarily buy groceries from Walmart and who also buy groceries online completed one or more eGrocery orders with Walmart during March 2024. For the households that primarily shop at a supermarket and buy groceries online, only 60 percent of those households bought groceries online from a Supermarket.

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Trendspotting: Online grocery sales four years after COVID-19 | Produce News - The Produce News

A positive polymerase chain reaction (PCR) result for SARS-CoV-2 was not associated with a new asthma diagnosis in children, according to a retrospective cohort study.

In adjusted analyses, PCR positivity for SARS-CoV-2 had no significant effect on the hazard of a new asthma diagnosis over 18 months of follow-up (HR 0.96, 95% CI 0.73-1.27, P=0.79), reported David Hill, MD, PhD, of the Children's Hospital of Philadelphia, and co-authors in Pediatrics.

Previous longitudinal studies have shown associations between acute wheezing illnesses among infants secondary to rhinovirus or respiratory syncytial virus (RSV) and later progression to asthma in childhood and adolescence, the authors explained.

"Smaller studies have isolated coronavirus strains from nasopharyngeal aspirates of infants and children during acute wheezing episodes or asthma exacerbations," they added. "However, each of these studies identified aspirates containing human coronaviruses 229E and OC43, coronavirus strains with low pathogenicity and mostly responsible for benign upper respiratory tract infections."

The current study examined a cohort of over 27,000 kids ages 1 to 16 years who were tested for COVID-19 during the first year of the pandemic. In the primary analysis, 1.81% of SARS-CoV-2-positive patients were subsequently diagnosed with asthma compared with 2.13% of SARS-CoV-2-negative patients.

"This study further benefits from a relatively unique period in history in which there was more uniformity in and control over environmental risk factors for asthma development," Hill and team noted. "Principally, the prevalence of other respiratory viral illnesses (including RSV, influenza, and rhinovirus) plummeted during the first year of the pandemic."

"This fact provided a natural opportunity to isolate the effects of SARS-CoV-2 from other respiratory viral infections," they continued. "Additionally, global improvement in pollution trends and air quality, coupled with greater isolation indoors, may have helped minimize exposure to outdoor toxicants and allergens while also minimizing variability between urban and rural settings."

Michelle Mann, MD, of Texas Children's Hospital and Baylor College of Medicine in Houston, told MedPage Today in an email that cough, wheezing, and bronchial reactivity can be seen in children with acute COVID-19 infection with or without an asthma diagnosis.

"The data are reassuring when discussing the prognosis with patients and families with COVID-19 infection and respiratory symptoms," she said. "We have seen in practice that most children with prolonged respiratory symptoms after COVID-19 infection will improve with time. However, the time course for resolution of respiratory symptoms can be much longer than other respiratory viruses."

Theresa W. Guilbert, MD, of Cincinnati Children's Hospital Medical Center, highlighted the environmental factors present during the pandemic.

"It is possible that our appropriate public health response to the pandemic -- social distancing, temporary suspension of school and work -- may have led to less exposure to respiratory viruses and other risk factors associated with asthma," she told MedPage Today. "For example, 1) less exposure to respiratory viruses, which may or may not be protective against asthma, 2) less exposure to pollution, which may be protective against asthma, or 3) increased maternal stress, which may lead to increased risk of asthma."

In the study, factors that significantly increased the hazard of new asthma diagnosis were Black race (HR 1.49, 95% CI 1.13-1.95, P=0.004), food allergies (HR 1.26, 95% CI 1.03-1.55, P=0.025), and allergic rhinitis (HR 2.30, 95% CI 1.93-2.74, P<0.001).

For children younger than 5 years, preterm birth (HR 1.48, 95% CI 1.13-1.93, P=0.005) and body mass index (HR 1.13, 95% CI 1.07-1.19, P<0.001) also significantly increased the hazard of new asthma diagnosis.

On the other hand, older age (ages 5-11: HR 0.27, 95% CI 0.22-0.34; ages 12 and up: HR 0.16, 95% CI 0.12-0.22) was associated with a significantly lower hazard of new asthma diagnosis.

For this study, Hill and team enrolled 27,423 children within the Children's Hospital of Philadelphia Care Network who received PCR testing for SARS-CoV-2 from March 2020 through February 2021. More than half were boys (52%), 39% were ages 5-11, 37.3% were ages 1-4, and 23.7% were 12 and older. Most kids were white (60.7%), and 21.3% were Black.

About 11% were born preterm, 12.7% had atopic dermatitis, 15.7% had a food allergy, and 43.6% had allergic rhinitis.

During the follow-up period, 573 children received an asthma diagnosis. The primary analysis defined asthma diagnosis as the presence of at least one corresponding ICD code for asthma, along with a prescription of an asthma-related medication.

Rates were similar in the sensitivity analysis, which used the secondary asthma diagnosis definition that required a corresponding ICD code for asthma at two or more follow-up visits at least 6 months apart, as well as a prescription of an asthma-related medication, with 1.12% of positive patients and 1.59% of negative patients diagnosed with asthma.

Hill and colleagues pointed to several study limitations, including the fact that it took place at a single institution and it relied on PCR test results for a 1-year exposure window only. In addition, "the exposure window preceded the evolution of several SARS-CoV-2 variants," and "it is possible that these later SARS-CoV-2 strains may influence asthma risk differently," they wrote.

Elizabeth Short is a staff writer for MedPage Today. She often covers pulmonology and allergy & immunology. Follow

Disclosures

This study was supported by the National Institutes of Health and the Children's Hospital of Philadelphia Research Institute.

The study authors reported no conflicts of interest.

Mann and Guilbert reported no disclosures.

Primary Source

Pediatrics

Source Reference: Senter JP, et al "COVID-19 and asthma onset in children" Pediatrics 2024; DOI: 10.1542/peds.2023-064615.

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COVID Infection Not Linked to New Asthma Diagnoses in Kids - Medpage Today

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Long COVID-19, or post-acute sequelae of SARS-CoV-2 infection (PASC), is a global health phenomenon characterized by persistent symptoms following the acute phase of COVID-19.

Affecting millions worldwide, it leads to sustained health care needs and impacts workforce participation due to symptoms such as fatigue and cognitive impairments. The condition highlights the necessity for ongoing research, health care system adjustments, and the formulation of targeted treatments to address its prolonged effects on individuals and economies.

A recently published study in Clinics has shed light on significant metabolic changes in non-vaccinated individuals with long COVID-19, offering key insights into disease severity. This study was led by Marvin Edeas, MD, Ph.D., Universit de Paris, Institut Cochin, INSERM 1016, France, and a team of international researchers led by Jumana Saleh, Ph.D., Sultan Qaboos University Hospital, Oman.

Published under the title "Reduced HDL-cholesterol in long COVID-19: A Key Metabolic Risk Factor Tied to Disease Severity," the study examined 88 patients across varying degrees of initial disease severity (mild, moderate, and severe) compared to a control group comprising 29 healthy individuals.

Findings from the controlled study revealed major metabolic shifts, particularly a substantial reduction in HDL-cholesterol (HDL-C) levels, coupled with a twofold increase in ferritin levels and insulin resistance among severe long COVID-19 cases, compared to milder cases and the control group. These metabolic markers emerged as leading predictors of disease severity, offering novel understandings of long COVID-19 management and treatment.

Edeas explained, "Our research has, for the first time, established a direct correlation between HDL-C and ferritin levels and the severity of long COVID-19. The decline in HDL-C levels and the rise in ferritin levels observed in patients, influenced by the severity of the initial infection, could potentially play a role in the persistence and progression of long COVID-19 symptoms." This study is critical in understanding long COVID-19 and its long-term impacts on metabolic health.

The research findings suggest that HDL-C and ferritin levels could serve as crucial markers and therapeutic targets, opening new avenues for treatment strategies aimed at mitigating the long-term effects of the disease. By considering these metabolic markers, we can shape preventive strategies and significantly mitigate the long-term impacts of COVID-19 on patients' health.

The observed correlation between diminished levels of HDL-cholesterol (HDL-C), the severity of COVID-19, and its prolonged course might be explained by HDL-C's function as a modulator of the immune response. This includes its roles as an anti-inflammatory, antioxidant, and antiatherogenic agent, particularly vital during the heightened inflammatory response triggered by the virus. Investigating HDL-C's utility beyond its conventional role in cholesterol transport is crucial for a comprehensive understanding of COVID-19 and its secondary health effects, such as long-COVID.

Extensive research indicates that COVID-19 precipitates notable shifts in the host's lipid metabolism, leading to the accumulation of cellular lipid reserves. These alterations aid in the viral takeover of host cellular mechanisms, thus facilitating the progression of the infection. This theory gains support from laboratory evidence showing the cessation of viral replication upon the administration of small molecule lipid inhibitors, highlighting the critical dependence of the virus on host lipid resources for replication.

A notable aspect of the interplay between HDL-C functionality and iron homeostasis is the process of ferroptosis, induced by lipid peroxidation and disturbed iron balance, characterized by the buildup of iron and products of lipid oxidation. This leads to diminished antioxidant defense capabilities. HDL-C is influential in mitigating the detrimental effects associated with ferroptosis, underscoring the significance of maintaining balanced iron levels in COVID-19 management.

"Our findings highlight the exacerbating effect of impaired iron regulation on COVID-19 progression, further complicated by the disrupted protective functions of HDL-C," stated Saleh.

The outcome of the "war," between the host's metabolic defenses and viral invasion strategies, axes on the control over iron and lipid resources. The virus strategically targets these metabolic reserves to support its replication and spread. For Edeas, this battle underscores the complex interaction between host metabolic pathways and viral mechanisms, emphasizing the strategic importance of iron and lipid regulation in determining the course and outcome of COVID-19 infection.

How does the strategic alteration of iron and HDL-C levels by a virus contribute to its underlying aim of targeting mitochondria to disrupt host defense mechanisms? Edeas, founder of World Mitochondria Society, commented on the perspective of this study.

"In the intricate dance of viral infection, the virus employs a calculated strategy aimed directly at the heart of the host's cellular energy and defense systemsthe mitochondria. By subtly manipulating and altering the host's iron metabolism and HDL-C levels, the virus orchestrates a multifaceted attack designed to undermine mitochondrial integrity and function.

"This strategic disruption serves to weaken the mitochondria, a crucial step in the virus's broader aim to compromise the host's ability to mount an effective defense. Through this sophisticated mechanism of action, the virus ensures its survival and proliferation within the host, highlighting the importance of understanding these viral tactics for the development of targeted therapeutic interventions."

The implications of this study are broad, providing a new understanding of long COVID-19's impact on metabolic health and laying the foundation for future research and therapeutic interventions aimed at improving patient outcomes.

More information: Jamila Al-Zadjali et al, Reduced HDL-cholesterol in long COVID-19: A key metabolic risk factor tied to disease severity, Clinics (2024). DOI: 10.1016/j.clinsp.2024.100344

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Study reveals HDL-C and ferritin as crucial markers for long COVID-19 severity - Medical Xpress

Wastewater testing has become a hallmark of viral surveillance during the COVID-19 pandemic, and a new study looking at samples collected near homeless encampments reveals novel viral mutations and transmission patterns and 26% of water samples containing SARS-CoV-2 genetic material. The study was published today in Environmental Science & Technology Letters.

Traditional wastewater monitoring relies on testing samples from local sewage infrastructure, which serves homes and apartment buildings. SARS-CoV-2infected people shed maximum viral RNA levels in fecal matter at the beginning of infection and for up to 7 months following the initial infection. Previous studies have shown wastewater samples have predicted when COVID-19 activity has spiked in a location, and identified variants of concerns.

To capture those changes among homeless people, researchers needed to sample waterways near encampments, and not traditional sewage lines. In the present study, water near encampments outside Las Vegas was sampled from December 2021 through July 2022.

Scientists collected the water from flood-control infrastructure that is known to be affected by homeless populations, the authors said.

They found that, of 57 samples obtained, 15 (26.3%) contained detectable levels of SARS-CoV-2 RNA, with highest concentrations in January and February 2022, which corresponded to peak Omicron activity in Las Vegas.

"These results demonstrate that environmental water samples from flood control channels impacted by unsheltered individuals appear to contain the same SARS-CoV-2 variants circulating in the broader community with some intermittent signals from previously circulating variants," the authors wrote.

These results demonstrate that environmental water samples from flood control channels impacted by unsheltered individuals appear to contain the same SARS-CoV-2 variants circulating in the broader community.

In subsequent whole-genome sequencing, the authors identified the SARS-CoV-2 variants in the waterways. Almost all variants matched what was seen in traditional sewage infrastructure. "However, we also detected 10 of 22 mutations specific to the Alpha variant in the environmental water samples collected during January 2022one year after the Alpha infection peak," they noted.

Analysis of viral sequences uncovered three novel viral spike protein mutations, but the authors said there was not enough information to determine if the mutations changed clinical outcomes for COVID-19 patients in the encampments.

"Due to a lack of clinical surveillance data for unsheltered individuals, we were unable to directly compare variant prevalence for the environmental water samples with this particular population," the authors said.

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Wastewater testing near homeless camps shows COVID-19 viral mutations - University of Minnesota Twin Cities

Two of the countrys top researchers on post-COVID conditions, commonly known as long COVID, have new clues as to who may be at risk for developing lingering symptoms, according to a recent study published in the American Journal of Medicine.

Dr. Harlan Krumholz and Akiko Iwasaki of the Yale School of Medicine found that being middle aged, female, and having had a severely acute COVID-19 infection is associated with long COVID. The question is why.

What was it about peoples age, sex, race, ethnicity how was that associated with long COVID? Krumholz said.

Researchers know that more women than men develop autoimmune diseases like lupus. Krumholz said further research is needed to find out whether long COVID is also an autoimmune disorder.

Meanwhile, long COVID patients and advocates are frustrated by how much even experts dont know about their condition.

Diana Berrent, founder of Survivor Corps, an online support group for long COVID patients nationally and in Connecticut, said patients need an Operation Warp Speed like approach to conducting randomized controlled trials and are instead being left to crowdsource off-label options via social media.

She said researchers should begin trialing antivirals, monoclonal antibodies, Vax-plasma, nicotine, low dose Naltrexone, vagus nerve stimulation and more.

We should be throwing the spaghetti at the wall, she said. Instead, we are ignoring the tremendous pain people are in, many of whom are celebrating their fourth year being bed bound.

The Yale study was based on self-reported COVID infections among 134,000 people in data from the 2022 Behavioral Risk Factor Surveillance System and the 2022 National Health Interview Survey.

The researchers found that individuals living in rural areas and people without college degrees had an increased risk of developing long COVID.

It could be that people who were more educated had better access to antiviral drugs like Paxlovid, Krumholz said.

Black Americans and non-Hispanic Asians were also less likely to report long COVID compared to non-Hispanic white people. Krumholz said thats a problem around health care access it could be that fewer Blacks and Asians had a doctor that they could reach.

Dr. Manisha Juthani, commissioner of the Connecticut Department of Public Health, said the paper utilized robust public health datasets and provides additional insights into how certain demographic risk factors and severity of COVID infection are associated with long COVID.

However, there was no data on up-to-date vaccinations and its protective factor against long COVID.

Other emerging evidence suggests that up-to-date COVID vaccination can be protective from long COVID, Juthani said.

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Certain US populations are more likely to get long COVID. Yale researchers are examining why - New Hampshire Public Radio

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Junior Associate Professor Kazuo Takayama (Department of Cell Growth and Differentiation) and a collaborative team of researchers in Japan recently characterized SARS-CoV-2 collected from a persistent COVID-19 patient to identify critical factors responsible for generating new mutant strains.

The COVID-19 pandemic, caused by the SARS-CoV-2, was in part due to rapid viral evolution that continuously generated new variants. While multiple factors are known to contribute to the rapid emergence of mutant strains, the principal contributing factors remain unclear.

In this study, accepted for publication in iScience, the researchers collected serum samples and viral isolates from an immunocompromised patient who was persistently infected by the SARS-CoV-2 omicron variant BF.5 over several months to track its evolution and potentially identify crucial factors responsible for the widespread effects of this respiratory virus.

Due to the patient's chronic immunosuppression as part of the treatment for eosinophilic fasciitis, the researchers detected only low antibody levels against SARS-CoV-2 in the samples. Conversely, although they detected cytolytic granules in the sera collected from the patient, suggesting that NK (natural killer) and CD8+ T cells were likely functional, the research team concluded that these immune cells alone, without sufficient antibody production by B cells, were incapable of successfully eliminating the virus from the patient.

The researchers next analyzed the viral genomes isolated from the swab samples by next-generation sequencing methods. Remarkably, whereas the viral genome mutated at 10 locations between the first and two sampling time points (days 0 and 17), it changed at 27 and 37 locations, respectively, during the second and third intervals between sample collection (days 1856 and 57119), suggesting the virus could acquire mutations quicker when left unchecked for more than two months.

Utilizing their expertise in organoid technology, the researchers examined the viruses' replicative capacity and their effects on host cells by infecting human iPS cell-derived lung organoids with each viral isolate. They detected similar viral gene expression and production levels across isolates, demonstrating that infectivity was generally unaltered during the entire course of a persistent SARS-CoV-2 infection.

In addition, the researchers examined the sensitivity to the antiviral drug, remdesivir, and anti-spike protein antibody therapy, sotrovimab, using lung organoids. All viral isolates showed high susceptibility to remdesivir treatment but were largely resistant to the antibody therapy, as they all contained spike protein mutations (G339D or R346T) known to render them resistant to sotrovimab. These findings indicate that infectivity and sensitivity to antiviral treatments remained mostly unchanged despite acquiring multiple mutations during the persistent infection.

To determine whether studying the viral isolates from a patient suffering from persistent SARS-CoV-2 infection can help predict viral evolution, the researchers focused on the S protein amino acid sequence and performed comparative phylogenetic analysis with emergent SARS-CoV-2 strains arising in the real world.

Notably, several mutations (D574N, S975N, S1003I, and A1174V), relatively rare before the appearance of BF.5, were acquired during persistent infection, indicating that they may be more likely to emerge from the BF.5 strain. The research team thus tested this idea by examining the frequency of these mutations in strains appearing after the BF.5 strain.

Remarkably, the D574N and S1003I mutations were detected in greater than 1% of descendant strains emerging from BA.5 (BA.5.24, BA.5.2.36, CG.1, BF.7.26, and BQ.1.1.21), thus demonstrating the potential and real-world implication of analyzing viral evolution in persistently infected patients.

In summary, the study illustrates the potential of studying how viruses change over time in patients with persistent infections as a parallel to predict how they may evolve in the real world. However, it is crucial to note that additional persistently infected patients must be included to determine the general applicability of such findings because individual differences could potentially skew viral evolution.

More information: Hiroki Futatsusako et al, Longitudinal analysis of genomic mutations in SARS-CoV-2 isolates from persistent COVID-19 patient, iScience (2024). DOI: 10.1016/j.isci.2024.109597

Journal information: iScience

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Researchers predict real-world SARS-CoV-2 evolution by monitoring mutations of viral isolates - Medical Xpress

OVER the past few years, I have noticed an increasing number of people sharing their experiences of feeling anxious, whether it is celebrities opening up in interviews or friends chatting over a drink. This got me thinking: are more people feeling anxious these days or are they just more willing to talk about it?

This apparent uptick seems to be seen in studies of anxiety prevalence but dig into the details and the picture isnt so clear. As for what is behind this possible rise, the covid-19 pandemic is an obvious cause, yet it isnt the only one: economic and political factors may also play a role.

Lets look at the pandemic first. It was a phenomenon that none of us had experienced, a global issue that understandably caused a huge amount of stress, says David Smithson at the charity Anxiety UK. Who wouldnt be worried?

Levels of anxiety rose at the start of the pandemic, with the World Health Organization reporting a 25.6 per cent increase in anxiety disorders in 2020 as lockdowns and other restrictions were brought in and people grappled with an unknown virus and its impact on their lives. But this rise didnt persist, according to a review of 177 studies looking at people in high-income countries, with levels falling as the pandemic continued.

This chimes with Smithsons experience. We saw that rise through demand for our support services from the start of the pandemic for about two years, he says. We have seen, in the last 12 months or so, that demand has dipped down

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Anxiety really has increased over the past 10 years but why? - New Scientist